Objective To discuss the prophylactic effect of handling inguinal nerves correctly duing Lichtenstein inguinal hernia repair on chronic pain after operation. Methods 158 patients with inguinal hernia who were treated in our hospital from February 2007 to March 2010 were given Lichtenstein hernia repair. The ilioinguinal nerves were carefully identified and preserved during the operation, the nerve excision had been carried on only in the cases of existing nerve injuried or interference with the position of the mesh. Results The identification rate of iliohypogastric nerve, ilioinguinal nerve, and genital branch of genitofemoral nerve was 87.97%（139/158）, 82.28%（130/158）, and 34.18%（54/158）, respectively. The postoperative complication rate was 5.06%（8/158）, in which subcutaneous hydrops 5 cases, scrotal hematoma 2 cases, and wound infection 1 case, all recovered by conservative management. There was not inguinal hernia recurrence in 12 months of follow-up. In 1 month after operation, there were 63（39.87%） patients suffered from mild pain and 34（21.52%） patients suffered from moderate pain in inguinal region, there was no patient with severe pain, the mean pain score was 0.83. The incidence of chronic groin pain in 6 months was 5.06% （8/158）, in which 7（4.43%） patients suffered from mild pain, and 1（1/158） patient suffered from moderate pain. In 12 months, only 4（2.53%） patients still experience occasional pain or discomfort, the mean pain score was 0.03. Multinomial logistic regression analysis indicated that neurectomy had no influence on postoperative pain（P＞0.05）and non-identification of ilioinguinal nerve was a risk factor for early（1 month） postoperative moderate pain（OR=3.373, P=0.030）. Conclusions Standard surgical procedure acted according to the Lichtenstein guidelines and handling inguinal nerves correctly can result in low incidence of chronic pain after operation, and can make the patients have a better quality of life.
【摘要】 目的 探討遠端胃癌根治術后早期經口進食的可行性、安全性及術后早期康復情況。 方法 將2009年5月-2011年1月收治的62例遠端胃癌根治術患者隨機分為早期經口進食（early oral feeding，EOF，30例）組及傳統進食（traditional feeding，TF，32例）組。比較兩種營養支持方法對患者術后并發癥、胃腸功能恢復及血清蛋白的影響。 結果 EOF組術后早期經口進食耐受率達90%（27/30），兩組術后并發癥發生率相比差異無統計學意義（χ2=0.046，P=0.830）。EOF組術后首次肛門排氣及排便時間均早于TF組（P=0.000）。術后8 d時EOF組血清前清蛋白和轉鐵蛋白明顯高于TF組（P=0.028，0.013）。 結論 遠端胃癌根治術后早期經口進食是安全、可行的，能促進患者的早期恢復。【Abstract】 Objective To discuss the feasibility and safety of early oral feeding after curative surgery for distant gastric cancer, and investigate whether it has an effect on early recovery of the disease. Methods From May 2009 to January 2011, 62 distal gastric cancer patients with open radical resection were divided into the early oral feeding group (EOF group, n=30) and traditional feeding group (TF group, n=32) randomly. We compared the complication rate, gastrointestinal function recovery, serum protein change before and after operation between the two groups. Results Early oral feeding can be tolerated by as much as 90% (27/30) of the patients in EOF group. There was no significant difference in the postoperative complication rate between the two groups (χ2=0.046, P=0.830). The EOF group had a faster onset of flatus and defecation than the TF group (P=0.000). The serum pre-albumin and transferrin were significantly higher in the EOF group than those in the TF group 8 days after operation (P=0.028,0.013). Conclusion Early oral feeding after curative surgery for distal gastric cancer is safe and feasible, and can promote early rehabilitation of the patients.